The suicide gap: Why men are more likely to kill themselves

Five years ago, Josh was standing on a bridge, texting his brother a good-bye message. He had been severely depressed for months, and the counselling that he was receiving and medication he was on wasn’t helping much. “I had lost all sight of ever getting better, and of anything enjoyable I’d ever done,” he says.

He jumped.

But he didn’t die.

Despite breaking six ribs and puncturing a lung, he woke up in the water. Adrenaline and instinct led him to swim to a nearby platform, where he was soon picked up by emergency services – his brother had received his text and called 911.

Today, Josh is doing much better. But he wonders what would have happened if he’d reached out for help earlier, before his depression worsened. “I basically never talked about my emotions with anybody; I felt like I wanted to figure things out on my own,” he says. “It was only when I was obviously really sick and ill that I reached out, because I couldn’t pretend anymore.”

He now works for HeadsUpGuys, a website based out of the University of British Columbia that focuses on men and mental illness. The experience has changed his perspective on why he didn’t feel comfortable asking for professional help earlier.

“Before, I never even thought of mental health in terms of what it means to be a man. [Through my work I realized] that I probably never asked for help because of those male stereotypes,” he says. “We have 11 story videos and a whole bunch of blogs on the site, and basically every time it’s they didn’t talk about their emotions with anybody, they wanted to figure it out on their own. You hear the same story [over and over again], and it’s my story too.”

Suicide is often thought of as a gender-neutral issue, but in reality, it’s a problem that affects men far more than women. Three times as many Canadian men kill themselves every year than women do – in Ontario, that means more men are dying from suicide than from car accidents.

That’s why many argue that suicide prevention programs should recognize that men are a high risk group and tailor messaging and programming to them. That’s starting to happen, with websites like HeadsUpMen and groups like Men’s Sheds, which offer a space and tools where men can gather to work on projects and make connections. Many of these are partially funded by the Movember Foundation, a men’s health organization, which has highlighted male suicide as one of its key areas of investment.

That’s mainly due to two things: “One is that men use more lethal means [to attempt suicide], and the second is that they don’t seek care as much,” says Simon Hatcher, vice-chair of research for the Department of Psychiatry at the University of Ottawa.

Men are more likely to use firearms and other deadly methods, while women are more likely to use pills. These differences might be because men are more comfortable with guns. Or it might be that, as some researchers have suggested, they’re choosing more extreme methods because they’re more suicidal in the first place.

Is masculinity getting in the way of getting help?

Having mental health issues is a major predictor for suicide – almost everyone who dies from suicide has an underlying mental health problem. “Ninety percent of people who die by suicide are experiencing some sort of mental illness or addiction, most often depression,” says Ed Mantler, vice president of programs and priorities at the Mental Health Commission of Canada. But not everyone with mental illness kills themselves. So what distinguishes those who do from those who don’t?

One thing is a strong support system. There’s evidence that men who adhere more strongly to masculine ideals see getting psychological help more negatively. That can result in their feelings building up without an escape valve – either a personal one, through talking with friends and family, or a professional one, through therapy or other mental health services – and can escalate to a crisis point. Studies show that in the year before they killed themselves, only 35 percent of men saw a mental-health practitioner, while 58 percent of women did.

“If a guy says, well my sense of being a man means that I can’t disclose any vulnerabilities, because that will make me look weak, if something [like depression] does come up, what do I do with that? I have to keep it to myself,” says John Oliffe, founder and lead investigator of the Men’s Health Research program at UBC.

He also questions the commonly held belief that women are more likely to suffer from mental illness than men are. “Historically these numbers have been bandied about – that women have twice the rate of depression, but men have higher rates of suicide,” he says. “But when you look more into contemporary epidemiological research, the numbers start to look a little different.”

That’s especially true when you consider that men’s symptoms of depression may be different than women’s. Instead of crying more, for example, Oliffe’s research has shown that increased anger, risk taking, irritability and substance abuse might be more common signs of depression in men. “Men will talk about not being able to sleep, about back pain, but they won’t say they’re feeling sad and incompetent,” says Julie Campbell, executive director of the Canadian Association for Suicide Prevention.

They do, however, interact with their primary care providers: Most men who kill themselves have seen their family doctor within the month. A new online course, certified by the College of Family Physicians of Canada, hopes to better educate family physicians about signs of suicide and depression in both men and women.

“Quite often we hear from family physicians that they’re reluctant to even ask questions [about mental health]. If your doctor doesn’t ask the question, it’s unlikely that most of us would volunteer that information,” says Mantler. “So providing physicians with the knowledge to have that conversation is important.”

Vulnerable groups

Some sub-groups of men are also more vulnerable to suicide: gay and transgender men, Indigenous men and those vulnerable to Post-Traumatic Stress Disorder, such as first responders and soldiers. Men who are in a lower socioeconomic class are also more likely to try to kill themselves.

Early life experiences also play a role: Having parents who separated early in their lives and a family history of suicide are much more predictive of men dying from suicide than they are for women.

And age is a factor. While suicide is often thought of as a young person’s problem, across Canada, Britain and the U.S., the group most likely to kill themselves are actually middle aged men. Nine of every 100,000 men 15 to 19 died of suicide, while 28 of every 100,000 who are 45 to 54 did. (The rate for women 45 to 54 is only 8.5 of 100,000.)

“It’s a bit of a myth that the most prevalent group is young people,” says Robert Whitley, Principal Investigator of the Social Psychiatry Research and Interest Group at McGill’s Douglas Hospital Research Center. “If you zero in on why it’s so high in the 40 to 60 age group, one of the key theories is that that’s an age where many men become unemployed or divorced.”

“What’s common is that many people felt they had a sense of predictability, meaning and purpose [in their jobs, marriages or role as a father.] There’s a sense that the carpet is being pulled out from under their feet, and a sense of alienation. Suddenly they feel completely rejected and misunderstood,” says Whitley

Solutions to prevent suicides

The big picture answer to this problem, says Oliffe, is addressing the issue of masculinity in our culture. “I really do think our society and culture needs to take collective responsibility in redefining what it means to be a man,” he says. He’s hopeful that the image of men needing to be “the sturdy oak” is diminishing in younger generations.

Campbell agrees – and says those shifts need to be embraced by women, too. “Men need to learn to do things differently, but women are not that comfortable with these changes. We always say that men should be able to cry more, but it’s any man but our man. We’re still a bit stuck in those roles, and we need to work on each side.”

Simply being aware of gender in our research and our approaches is another key step. “To ask, are there times where we need to have different approaches in men and women? Even that is very powerful,” says Joy Johnson, vice-president of research at Simon Fraser and formerly the Scientific Director for the Institute of Gender and Health at the Canadian Institutes of Health Research. “We need to start to systematically think about an approach that could reach out to men and boys.”

Some examples exist from around the world: The U.S. Air Force successfully dropped suicide levels beginning in the 1990s by setting up 11 initiatives which normalize distress, encourage seeking help and educate leadership about warning signs of suicidality. After the program started, the mean suicide rate dropped from 3 per 100,000 to 2.4 per 100,000.

When Ireland had a spike in men’s suicides, they adopted Australian’s Men’s Sheds initiative, where men gather to complete projects and chat, reducing isolation in older and unemployed men in particular. Canada has also recently started embracing men’s sheds. (There is evidence that the sheds reduce isolation, though their direct effect on mental health is still unproven.)

Offering more mental health resources online and through apps might be one way to make those services more attractive to men. “Online approaches for most men work much better. We need to give them a mechanism to find out answers on their own before they’re ready to seek help,” says Johnson. “And there is a real bias towards cognitive behavioural therapy, because it’s action oriented – you create plans, you do things. The nice thing about that is it can be offered online, too.”

The number of websites tailored to men’s mental health is growing. #SickNotWeak, which was created by sports journalist Michael Landsberg, encourages users to talk about mental illness. Kids Help Phone started a “BroTalk” portal in 2015, that’s tailored to teenage men. And Head’s Up Guys, which is based out of UBC and which Oliffe consulted on, has seen 350,000 visitors since it launched in 2015. He hopes its simple design and action-oriented terms – like “act early and decisively” or “get the upper hand on depression early” – will help men feel more comfortable.

“We have very purposeful language,” says Oliffe. “We speak to guys directly, and use language that doesn’t complicate their health and (doesn’t) complicate what depression is.” Some 40,000 visitors to the site have used its self-check section, which asks about symptoms of depression. Exact numbers aren’t available yet, but many of the site’s users reported feeling suicidal every day.

A similar site in the U.S., called Man Therapy, uses humour to make men more comfortable with talking. It highlights messages like “a moustache is no place to hide your emotions” and “sometimes a man just needs a pork shoulder to cry on,” and features informative videos from “Dr. Rich Mahogany.” The site includes personal stories from men who have overcome mental illness and a self-assessment tool for depression and anxiety – what it calls a “head inspection” – and directs people to self-help resources, crisis hotlines, and local therapists.

Within 18 months after launch, the site had had more than 350,000 visitors, nearly 60,000 of whom completed the “head inspection.” Some 17 percent said the thing they liked most about the site was that it was manly. Fifty one percent of people who answered a pop-up survey on the site said they were more likely to seek help after visiting it. It was co-created by the Colorado Department of Public Health and Environment and a marketing company, and versions have since spread to other parts of the U.S. and to Australia. It has also been customized for first responders.

And of course, the last part of this is making sure that mental health resources are there for the men and women who do reach out by investing more in mental health, especially psychotherapy.

“People are always contacting me, like ‘I need some help, but I can’t pay,’ and I’m handcuffed, there’s no one to send them to,” says Oliffe. “But the main problem is that men aren’t coming through the door in the first place.”

If you are feeling suicidal, click here for a list of resources in your area.

Enter the debate: reply to an existing comment

21 comments

SharonAugust 11th, 2017 at 9:51 pm

This article contains good information and resources. As a mother of a son who died by suicide I would love to see these same experts and resources turn their expertise and research experience towards what I believe to be perhaps the biggest, darkest secret attached to suicide and the rising epidemic of it … MEDICATION!! The medication itself which is often prescribed as the save-all tool of treatment can help to contribute to suicide. This phenomena is under-reported and under-researched. Little or no data is collected on this. Prescription medication – whose packaging itself includes disclaimers of the adverse effects – can be, has been and is the culprit in an unknown % of suicide and suicide attempts. If we are going to tackle this growing epidemic head-on … let’s look at ALL potential contributing factors.

I’m sorry for your loss and in this world, being a man does kinda suck but your son shouldn’t feel like a failure. I know I’m not superman but I don’t discriminate. It’s hard to trust someone if you want to have to talk to someone. I have experienced suicidal thoughts myself and I’ve talked to someone about it despite being a man myself. Your son isn’t alone on this and shouldn’t have to be. Remember this, I’m only 21 and not 47. It doesn’t matter how old you are, people will try to attack you anyway they could.

I’m so sorry to hear about that. I agree medication is a real problem in many cases. I was prescribed this stuff in the 90s when I was a moderately depressed teenager. I became suicidal after trying the pills. I stopped and told the doctor. They refused to hear me and said the suicidal feelings were proof I needed the pills, and I had to try again. So I did, and again the same feeling. The doctors still refused to listen and were very condescending about it. A few years later all the warnings started getting added to the boxes saying exactly what I’d been trying to tell these pigheaded doctors.

100% agreed!!!! Maybe if the family courts would stop ripping families apart for their shareof the cash cow. Many men would live and thrive even in the most poverty stricken areas, why? Because they have meaning and don’t have a money hungry court system forcing young men and women to grow up without fathers.

Nailed it. Carry the load for all those that they love while being told they are worthless. Your kids don’t need a Dad..what they really need is a Mom and you money. Well, maybe that accounts for absentee fathers, dad’s moving out of state after divorce, and yes self inflicted death. Who doesnt want to be forced in a court to justify them being allowed to spend time with their children? Yep, men kill themselves more. It isn’t suicide. They kill themselves. That is the intent, it isn’t a cry for help.

There is certainly clinically depressed men, and I don’t mean to say there isnt. Some suicide is a result of clinical depression. But the differential is due to family and court systems.

I think if Psychiatry was not the model it is today, where every behaviour or word or human emotion is diagnosed as mental illness, which is worse than having a criminal record, more people would want to talk to someone.
The pills dished out, the silly diagnosis themselves cause more harm than good.
The problem is if any man mentions suicide, his feelings are validated by being able to ‘hold’ him. We need a system where much of human distress or thoughts, feelings are not made into pathological issues, but human issues.
Now everyone has to pretend they are superhuman. It helps to be in powerful positions since then you can hide by control.
Stigma is reignited by just talking about stigma. The very people that talk about reducing stigma are flaming fires. Stigma exists because of the silliest diagnosis. The man who wants to commit suicide does not need a diagnosis.
He does not even need control or pills. Those pills are the next biggest lie to the DSM.
Even the doctors don’t believe in that model. Suicide has always been around and is on the rise. It is not against the law.
It hurts families. But we can’t fix it with current models of psychiatry. The current model stinks and ruins lives forever.
The best fix is a close friend, but even they cannot prevent what is felt as a tragedy by those left behind.
It is extremely dangerous to prescribe any pills to a person in crisis. It is a well known fact that they do not work. Feelings are in movement, people grow, change is happening until we die. Diagnosis is useless because of the fluid nature of life.

We know by our intellect that psychiatry as a current model will not survive.
Intellect and a belief system and education are worlds apart.
Psychiatry needs to let the pen go and identify and open up to their equal which is a human being in pain across from them. They cannot stop a suicide anyway, so why not simply become a mensch. But then that is a personality thing and cannot be taught.

The problem is that even when men reach out for help they get shouted down by everyone around them.. and now the world post 2014 has just gotten cruler and meaner and only getting worse as society divides more… even my parents have been turned against me and no one seems to care about anyone else even when your desperately trying to reach out for help…

I get sick every time people call depression a mental Illness……I am depressed because I was raped when I was a 3 year old boy, not because my brain is diseased! That’s why I don’t care to seek any help.

I totally understand. Your mad, your angry and the stupid label society wants to put on you doesn’t fit. When I first spoke out about my abuse life just got worse but it’s the only way to heal your sole. We as men need to listen to each other and not be judgmental or afraid

Family court in this country is literally killing men. It’s destroying children lives and not only allowing women to abuse men but seems to encourage it. The lack of equality is a very depressing state of affairs. Just a small piece of evidence to thus fact is the brochure for a protection order. Yes it says these laws apply to men in the last sentences of the brochure but to look at he pictures of the 4 females of the cover and then read the brochure it’s hard to get a sense these laws apply for men. 25 year of 50/50 domestic abuse but not one shelter for men and children in this country

Really? You are not sure why men end their lives at a certain age? At any moment my Male pattern baldness genes could kick in, making progressing in my career or finding a wife extremely difficult, and no one will care, and if I did end my life, I would be too ashamed to let that be the reason. Get serious.

Many men are topping themselves because they live in a society that keeps crapping all over them, and telling them that they are evil and responsible for everything that goes wrong in the world, yet it keeps expecting these same men to put their noses to the grindstone and do all the heavy lifting. Add in anti-male laws and divorce courts and a constant diet of misandry in the media and popular culture to the mix for added effect.

It’s a case of having all responsibilities, but no rights and no respect.

We keep endlessly talking about the problem of male suicide but then we have situations like this:

“People are always contacting me, like ‘I need some help, but I can’t pay,’ and I’m handcuffed, there’s no one to send them to,”

If we were truly serious about beginning to address the problem, then we would find a way to make sure that men get the help and therapy they need without worrying about whether they can pay or not.

For men the cause is not just depression but situational depression. The term is called FCDD. “family court disenfranchised disorder.” Family court literally destroys many mens lives

For teenage boys and girls the cause is not just depression but situational depression. The term is called NADD or NFD. “Never adopted disorder,” or “no father disorder.” Children born out of wedlock have no rights, hence the term illegitimate, and 70 % of children who grow up without fathers lived destroyed lives

all though these terms are made up, they describe the matters more accurately

The sad thing in life for men is this: Men will almost forever think that we can’t cry, we can’t show our vulnerabilities, we can’t show any sad or depressed feelings to the world because we’ll feel like we’re going to be made fun of, insulted, mentally abused, etc. Us men feel the need to always be tough, no matter what happens, and sometimes we can do that,
some of us can’t keep it up like that our whole lives. It’s saddening to know that so many men feel this way, including me, feeling like we can do it, but then figuring out later that all the things that we’ve done were slowly destroying ourselves our whole lives. We then feel like we’re misunderstood, misused, left to die on the inside. It’s hard to deal and cope with, and most of us hate the fact that we have to feel like a “man” in order for us to feel better about ourselves.

This idea that men have a safe place to report suicidal feelings is insane. Try telling a doctor or a priest you are considering chewing on a gun barrel, taking an O.D. , or hanging your self, and you’ll have have a SWAT team kicking down your door before you know it. There is no privacy or confidentiality.

This document is provided under the terms of a CreativeCommons Attribution Non-commercial Share Alike license. The terms of the license are available at: http://creativecommons.org/licenses/by-nc-sa/3.0/. Attributions are to be made to HealthyDebate.ca, a project under the direction of Dr. Andreas Laupacis, at the Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital.